Physician (Medical Advisor)
4 weeks ago
The Physician Advisor-Care Management and Clinical Documentation Improvement (PACM) is a full-time administrative physician role serving Good Shepherd Hospital - Longview and its affiliates through teaching, consulting, and advising both the Care Management Department and the medical staff on matters regarding physician practice patterns, documentation, over- and under-utilization of resources, medical necessity, compliance rules and regulations, collaboration and relationships with payers, and the community. The PACM also ensures physician support and execution for the Care Management and CDI Departments' initiatives by promoting effective and efficient physician documentation to support the patient's Level of Care (LOC), billing status, and appropriateness of Medicare Severity-Diagnosis Related Group (MS-DRG)/DRG assignment. The PACM will submit monthly time records documenting time actually spent in the provision of the responsibilities outlined below.
The Physician Advisor-Care Management and Clinical Documentation Improvement role should be staffed by a physician with the following qualifications:
Certified by the American Board of Quality Assurance and Utilization Review Physicians, Inc (ABQUARP) - preferred
Served on or chaired a Utilization Management committee
Physician Advisor - Care Management & CDI Duties and Responsibilities
Utilization Management Plan: 20%
In collaboration with the Director of CM, lead the Utilization Review Committee
In collaboration with the Director of CM, monitor key metrics for UM and participate in action steps to achieve targets. Physician & Staff Education: 15%
Provide education to physicians and other clinicians related to regulatory requirements, appropriate billing status and utilization of alternate levels of care, community resources, and end of life care.
Work with physicians to facilitate referrals to the continuum of care
Provide mentoring/coaching to UR Case Managers to increase knowledge in care progression
Care Management: 50%
Participate in daily IDRs takes action to expedite testing and treatment to promote efficient patient care and appropriate LOC
Provides guidance/assistance to the Emergency Department Physicians and CM staff to assure correct LOC designation at intake
Participate in review of long stay patients escalated from Care Management to facilitate the use of the most appropriate LOC
Review cases that indicate a need for issuance of a hospital notice of non-coverage determination. Document patient care reviews, decisions, and other pertinent information per hospital policy
Participate in Care Management Leadership & staff meetings to help identify and progress toward departmental goals
Notify the Care Manager of any conflict of interest in reviewing a particular patient record.
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Longview, TX, United States CHRISTUS Health Full timeDescription Roles and Responsibilities Overview The Physician Advisor-Care Management and Clinical Documentation Improvement (PACM) is a full-time administrative physician role serving Good Shepherd Hospital - Longview and its affiliates through teaching, consulting, and advising both the Care Management Department and the medical staff on matters...
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Longview, United States CHRISTUS Health Full timeDescriptionRoles and Responsibilities OverviewThe Physician Advisor-Care Management and Clinical Documentation Improvement (PACM) is a full-time administrative physician role serving Good Shepherd Hospital - Longview and its affiliates through teaching, consulting, and advising both the Care Management Department and the medical staff on matters regarding...
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